Mapping CT Orderables to RadLex Playbook IDs for Submission of Radiation Dose Structured Reports to the ACR Dose Index Registry: One Institution's Experience Mark P. Supanich, Ph.D. Michael Flynn, Ph.D. Safwan Halabi, MD Matt Vanderhoek, Ph.D. Henry Ford Health System

Background To be processed by the American College of Radiology’s (ACR) Dose Index Regristry (DIR) system all studies must have a Radlex Playbook ID (RPID) assigned Mapping of CT Orderables using a schema allows comparison of radiation dose of similar exams across institutions RPID for CT Orderable built by assigning component terms (such as Head) to predicate fields (such as Body Region)

Background One-time retrospective mapping of CT study descriptions submitted to the DIR was completed by RadMapps earlier this year Any new facilities or new exams submitting to the DIR will have to be mapped to the proper RPID either retrospectively (after submission) or prospectively (pre-submission)

Procedure for Retrospective Mapping Radiation Dose Structured Report (RDSR) with study description transmitted from facility via ACR’s TRIAD server and software to the DIR User logs on to DIR and selects “Exam Mapping Tool” User maps each study description to the proper RPID Some suggested mappings may be available via search tool Instructions for mapping tool: https://nrdr.acr.org/Portal/HELP/DIR/ACRUserGuideDIRMappingTool.pdf

Procedure for Retrospective Mapping Select Exam Name Mapping from menu

Procedure for Retrospective Mapping Filter by “Not Tagged”

Procedure for Retrospective Mapping Option 1: Enter in values for predicates in search tool and select matching RPID

Option 1I: Manually map predicates and values and request RPID Procedure for Retrospective Mapping Option 1I: Manually map predicates and values and request RPID

Issues with Retrospective Mapping Some orderables/exams may have different study descriptions on different systems Study descriptions can come from worklist or mannually entered in at console Study descriptions may not be as detailed as required to differentiate amongst different exams Example: CT Abdomen Pelvis with Contrast Number of phases not included in study description Information about low dose studies may not be included in study description Anatomic focus may not be included in study description

Prospective Mapping One time mapping of facility orderables/exam codes to RPIDs Requires initial investment of time Team approach to mapping Our institution’s team included CT Physicist Radiologist Physics Resident CT Technologist Our team used the institution’s charge master for mapping

Procedure for Prospective Mapping Instructions and information on Prospective Mapping available at the Radlex Playbook website http://playbook.radlex.org/playbook/SearchRadlexAction Radlex Playbook team available to respond to inquiries and answer questions Prior to mapping, assemble list of CT Orderables with associated procedure code and study description to map

Download CT template from Playbook website Procedure for Prospective Mapping Download CT template from Playbook website

Procedure for Prospective Mapping Import orderables and codes and map values for orderable into predicate fields

Procedure for Prospective Mapping Send completed spreadsheet to Playbook team and receive spreadsheet with orderables mapped to RPID

Procedure for Prospective Mapping Mapped RPID appended/inserted into RDSR and appears in exam detail view

Appending RPID to RDSR To be processed by the DIR the RPID for the orderable must be sent along with the exam The RPID can be appended to the DICOM header of the RDSR in the Procedure Code Sequence A number of ACR DIR partners currently offer the ability to use a look-up-table of orderables and RPIDs to send the appropriately modified data to the DIR

Benefits to Prospective Mapping Availability of More Detailed information Reduced Dose/Standard Dose may have same study description but different orderables Study descriptions may be same but have different reasons/anatomic foci Self-mapping is more accurate Able to refine in future for more granularity A better apples to apples comparison Especially important for multiphasic studies Allows for easy tagging of reports with Radlex keywords

Benefits to Retrospective Mapping/Facility Experience Single spreadsheet with orderables and RPID HFHS has included a column for master protocols as well Easy to visualize Protocol to Orderable to RPID Utility for analyzing semi-annual reports Take RPID name from report Match to Facility Orderable (more specific than Study Description) Allows in depth investigation into anomalies

Investigate why exam DLP is high – with direct mapping to orderable and protocol may find that exam is multiphasic

Evaluation Population of the spreadsheet with the proper predicate terms for 200 orderables took several hours Approximately 50 orderables could not be immediately mapped due to missing RadLex terms Missing terms were added by the Playbook team allowing complete mapping of our diagnostic CT orderables to RPIDs Our institution uses the commercially available software package eXposureTM from Radimetrics to submit data and RPIDs to the DIR No Retrospective Mapping has been required